Hello!

Congratulations! Your child has been nominated by their school to Talkshop Speech Pathology's Sponsorship Program. This means that we are offering your child a comprehensive speech pathology assessment and 1 term of weekly therapy. We are looking forward to working with you and your child's teacher to support your child's learning and development.

When we set up Talkshop Speech Pathology, we wanted to make sure that we supported the local community, in particular, local families. So, for every new speech pathologist in our team, we set up a new Speech Pathology Sponsorship Program with a local school. You child has been nominated by their teacher. We would like to complete the necessary assessments in the school holidays so we can start therapy sessions in week 1 of next term.

Please highlight all statements in which you have some concerns for your child's development There is a section at the end to make additional comments. Your perspective as their parent is gives us insight into how they are going with their speech, language, literacy and social development skills at home compared to their school life.

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Thank you,
Talkshop Speech Pathology

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Child's Information

First Name

Date of Birth

What is the primary language spoken at home?

Last Name

Age

Please create a unique client ID for future reference. Please use your child's first name followed by your mobile number with no spaces

Please list any other languages your child speaks

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School

Name of school

Class Name

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About your child

Do you have areas of particular concern?

Does you child have any current or relevant medical diagnoses?

Has you child ever seen a Speech Pathologist in the past? Please describe

Describe when your child reached developmental milestones. Sitting, Crawling, Walking, Talking

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Your Contact Details

First Name

What is your relationship to your child

Mobile Number

Address

Last Name

Home Phone

Suburb

Post Code

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National Disability Insurance Scheme Participants

Please leave this blank if your child is not an NDIS participant

NDIS Number

SUBMIT